Biomedical subjects

B H Marcus

Publications and source records attributed to B H Marcus.

At least 19 recordsLinked to original sources

PubMed2001

Physician-based activity counseling: intervention effects on mediators of motivational readiness for physical activity.

In theory-based interventions for behavior change, there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs. These two questions are addressed in the Physically Active for Life study, a randomized trial of physician-based exercise counseling for older adults. Three hundred fifty-five patients participated (intervention n = 181, control n = 174; mean age = 65.6 years). The underlying theories used were the Transtheoretical Model, Social Cognitive Theory and the constructs of decisional balance (benefits and barriers), self-efficacy, and behavioral and cognitive processes of change. Motivational readiness for physical activity and related constructs were assessed at baseline, 6 weeks, and 8 months. Linear or logistic mixed effects models were used to examine intervention effects on the constructs, and logistic mixed effects models were used for mediator analyses. At 6 weeks, the intervention had significant effects on decisional balance, self-efficacy, and behavioral processes, but these effects were not maintained at 8 months. At 6 weeks, only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes. Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults.

Aged↗

PubMed2001

Maintenance of physical activity following an individualized motivationally tailored intervention.

This study examined predictors of exercise maintenance following completion of a physical activity intervention. Sedentary adults recruited through newspaper advertisements were randomly assigned to receive either (a) a motivation-matched intervention with feedback reports that were individually tailored (IT) to psychological variables from social cognitive theory and the Transtheoretical Model via computer expert system, or (b) a standard, print-based intervention (ST). The intervention phase of the study included mailed assessments and intervention materials at baseline, 1, 3, and 6 months. An assessment-only follow-up was conducted 6 months after the end of the intervention (Month 12). Participants were assessed for current physical activity participation, motivational readiness for physical activity, a number of psychological constructs posited to influence participation in physical activity (e.g., self-efficacy), and current affect. Significantly more participants in the IT condition met or exceeded exercise participation goals at the end of the intervention period and maintained this level of physical activity through the Month 12 follow-up compared to ST participants. Prospective analyses revealed significant differences in several psychological constructs both at program entry (baseline) and the end of the intervention period between individuals who maintained their physical activity participation through Month 12 and those who did not. Results suggest that the maintenance of physical activity following the end of an active intervention program may be influenced by attitudes and behaviors acquired along with increased participation in physical activity, as well as by preexisting characteristics that individuals bring into treatment.

Adult↗

PubMed2000

Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE.

BACKGROUND: Project ACTIVE was a randomized clinical trial comparing two physical activity interventions, lifestyle and traditional structured exercise. The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults. DESIGN: This was a randomized clinical trial. SETTING/ PARTICIPANTS: The study included 235 sedentary but healthy community-dwelling adults. INTERVENTION: A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised, center-based exercise. MAIN OUTCOME MEASURES: The main outcome measures of interest included cost, cardiorespiratory fitness, and physical activity. RESULTS: Both interventions were effective in increasing physical activity and fitness. At 6 months, the costs of the lifestyle and structured interventions were, respectively, $46.53 and $190.24 per participant per month. At 24 months these costs were $17.15 and $49.31 per participant per month. At both 6 months and 24 months, the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures. CONCLUSIONS: A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health. This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy, sedentary adults.

Adult↗

PubMed2000

Interactive communication strategies: implications for population-based physical-activity promotion.

Physical inactivity is a recognized independent risk factor for the development of cardiovascular disease. However, a large proportion of the U.S. population does not participate in regular physical activity, and research has shown that without intervention, most people remain sedentary. Thus, an urgent need exists for developing effective interventions to promote physical-activity adoption and maintenance. Additionally, it is important that these interventions can be disseminated to the large population of sedentary individuals. To be disseminable, physical-activity interventions must move beyond reliance on strictly face-to-face modes and begin to more fully use newer technologies, such as the Internet. This article summarizes the progress made in promoting physical activity with interactive communications. We also delineate areas for future research.

Cardiovascular Diseases↗

PubMed2000

Physical activity behavior change: issues in adoption and maintenance.

The many benefits of participation in regular moderate- or vigorous-intensity physical activity are well established, yet more than 60% of the population is sedentary or insufficiently active. Published studies have revealed that behavior modification and cognitive-behavior modification can be successfully used to assist patients, healthy adults, and youth in the adoption of physically active lifestyles. However, few studies with adults and youth have examined the maintenance of physical activity behavior beyond 6 months of adoption of this behavior. Maintenance of physical activity is critically important because ongoing participation in the behavior is necessary to sustain health benefits. Knowledge of effective intervention strategies for long-term maintenance of physical activity is at an early stage. The authors provide a summary of what is known about the maintenance of physical activity behavior in adults and youth and how physical activity behavior relates to other health behaviors such as smoking, as well as recommendations for research on physical activity behavior change and maintenance.

Adolescent↗

PubMed1999

The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial.

BACKGROUND: Smoking prevalence rates among women are declining at a slower rate than among men. OBJECTIVE: To determine if exercise, a healthful alternative to smoking, enhances the achievement and maintenance of smoking cessation. METHODS: Two hundred eighty-one healthy, sedentary female smokers were randomly assigned to either a cognitive-behavioral smoking cessation program with vigorous exercise (exercise) or to the same program with equal staff contact time (control). Subjects participated in a 12-session, group-based smoking cessation program. Additionally, exercise subjects were required to attend 3 supervised exercise sessions per week and control subjects were required to participate in 3 supervised health education lectures per week. Abstinence from smoking was based on self-report, was verified by saliva cotinine level, and was measured at 1 week after quit day (week 5), end of treatment (week 12), and 3 and 12 months later (20 and 60 weeks after quit day, respectively). RESULTS: Compared with control subjects (n = 147), exercise subjects (n = 134) achieved significantly higher levels of continuous abstinence at the end of treatment (19.4% vs 10.2%, P = .03) and 3 months (16.4% vs 8.2%, P=.03) and 12 months (11.9% vs 5.4%, P=.05) following treatment. Exercise subjects had significantly increased functional capacity (estimated VO2 peak, 25+/-6 to 28+/-6, P<.01) and had gained less weight by the end of treatment (3.05 vs 5.40 kg, P = .03). CONCLUSIONS: Vigorous exercise facilitates short- and longer-term smoking cessation in women when combined with a cognitive-behavioral smoking cessation program. Vigorous exercise improves exercise capacity and delays weight gain following smoking cessation.

Adult↗

PubMed1999

Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial.

CONTEXT: Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity. OBJECTIVE: To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors. DESIGN: Randomized clinical trial conducted from August 1, 1993, through July 31, 1997. PARTICIPANTS: Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively. INTERVENTIONS: Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program. MAIN OUTCOME MEASURES: Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months. RESULTS: Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals [CIs]) were 0.84 (95% CI, 0.42-1.25 kcal/kg per day; P<.001) and 0.69 (95% CI, 0.25-1.12 kcal/kg day; P = .002) for activity, and 0.77 (95% CI, 0.18-1.36 mL/kg per minute; P = .01) and 1.34 (95% CI, 0.72-1.96 mL/kg per minute; P<.001) for VO2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 [95% CI, -5.54 to -1.72 mm Hg; P<.001] and -3.26 [95% CI, -5.26 to -1.25 mm Hg; P = .002]) and diastolic blood pressure (-5.38 [95% CI, -6.90 to -3.86 mm Hg; P<.001] and -5.14 [95% CI, -6.73 to -3.54 mm Hg; P<.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 [95% CI, -1.05 to 0.96 kg; P = .93] and 0.69 [95% CI, -0.37 to 1.74 kg; P = .20]), but each group significantly reduced their percentage of body fat (-2.39% [95% CI, -2.92% to -1.85%; P<.001] and -1.85% [95% CI, -2.41 % to -1.28%; P<.001]) in the lifestyle and structured activity groups, respectively. CONCLUSIONS: In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.

Adult↗

PubMed1998

Effect of smoking cessation on exercise performance in female smokers participating in exercise training.

We evaluated in a randomized prospective trial the possible effect of smoking cessation on exercise performance in middle-aged female smokers who underwent vigorous exercise training as an adjunct to a cognitive-behavioral smoking cessation treatment program. A total of 109 subjects met the criteria for this substudy; of these, 51 were in the contact control (nonexercising) group and 58 were in the exercise training group. Both groups had a graded maximal exercise stress test performed on a bicycle ergometer before and after 12 weeks of treatment. All subjects participated in a 12-session, group-based, cognitive-behavioral treatment program for nicotine dependence. Subjects in the contact condition participated in 3 supervised health education lectures per week but did not engage in regular exercise. Subjects in the exercise group trained 3 times a week, averaging 83% of maximum heart rate achieved on their baseline exercise test. On the 12-week exercise stress test, the exercise group did significantly better than control in all aspects of exercise performance. Those who quit showed a further increase in their exercise test duration (p <0.001) and had a greater increase in calculated peak oxygen consumption expressed as fat-free weight (p = 0.031). In conclusion, women who undergo a vigorous exercise training program and quit smoking demonstrate improved exercise performance over those who continue to smoke.

Adult↗

PubMed1998

Efficacy of an individualized, motivationally-tailored physical activity intervention.

This study compared the efficacy of two low-cost interventions for physical activity adoption. Sedentary (N = 194) adults recruited through newspaper advertisements were randomized to receive either a motivationally-matched, individually-tailored intervention (IT) or a standard self-help intervention (ST). Assessments and interventions were delivered by repeated mailings at baseline, one, three, and six months. Participants were assessed regarding current physical activity behavior, motivational readiness to adopt regular physical activity, and psychological constructs associated with physical activity participation (e.g. self-efficacy, decisional balance). Repeated measures analyses of variance (ANOVAs) revealed significant increases in physical activity participation between baseline and six months for both groups with a significantly greater increase among IT participants. The IT group outperformed the ST group on all primary outcome measures: (a) minutes of physical activity per week, (b) reaching Centers for Disease Control and American College of Sports Medicine (CDC/ACSM) recommended minimum physical activity criteria, and (c) achieving the Action stage of motivational readiness for physical activity adoption. Both groups showed significant improvement between baseline and six months on the psychological constructs associated with physical activity adoption (e.g. self-efficacy), with no significant differences observed between the treatment groups. Utilizing computer expert systems and self-help manuals to provide individually-tailored, motivationally-matched interventions appears to be an effective, low-cost approach for enhancing physical activity participation in the community.

Adult↗

PubMed1998

Physical activity interventions using mass media, print media, and information technology.

INTRODUCTION: Media-based physical activity interventions include a variety of print, graphic, audiovisual, and broadcast media programs intended to influence behavior change. New information technology allows print to be delivered in personalized, interactive formats that may enhance efficacy. Media-based interventions have been shaped by conceptual models from health education, Social Cognitive Theory, the Transtheoretical Model, and Social Marketing frameworks. METHODS: We reviewed 28 studies of media-based interventions of which seven were mass media campaigns at the state or national level and the remaining 21 were delivered through health care, the workplace, or in the community. RESULTS: Recall of mass-media messages generally was high, but mass-media campaigns had very little impact on physical activity behavior. Interventions using print and/or telephone were effective in changing behavior in the short term. Studies in which there were more contacts and interventions tailored to the target audience were most effective. CONCLUSION: A key issue for research on media-based physical activity interventions is reaching socially disadvantaged groups for whom access, particularly to new forms of communication technology, may be limited. There is a clear need for controlled trials comparing different forms and intensities of media-based physical activity interventions. Controlled studies of personalized print, interactive computer-mediated programs, and web-based formats for program delivery also are needed. The integration of media-based methods into public and private sector service delivery has much potential for innovation.

Adolescent↗

PubMed1998

Longitudinal changes in college students' exercise participation.

A 4-page questionnaire was mailed to 708 randomly selected 1st-year university students to assess changes in the students' exercise behavior from the 1st year of college to the 2nd year. The questionnaire assessed student demographics and participation in vigorous and moderate exercise over the preceding 7 days. Three hundred thirty-two students responded. A year later, a similar questionnaire was mailed to the same 332 students; responses were obtained from 242 students. Although no changes in reported exercise participation were found in the group as a whole, subgroups of students who either increased or decreased exercise participation were identified. Implications for exercise intervention programs among college students are presented.

Adolescent↗

PubMed1998

A randomized trial of physical activity interventions: design and baseline data from project active.

We report here the design and baseline data from Project Active, a 2-yr randomized trial designed to compare the effectiveness of a Lifestyle physical activity intervention with the traditional Structured exercise prescription approach. Primary outcome measures are energy expenditure in physical activity (estimated by kcal per kilogram of body weight of energy expenditure) and cardiorespiratory fitness (measured by maximal oxygen uptake). The participants, 235 initially sedentary and apparently healthy adults, were randomized into either the Lifestyle or Structured intervention groups. The Lifestyle treatment consists of a personalized approach that accounts for an individual's motivational readiness and preferences for integrating physical activity into daily routines. The Structured approach is the familiar exercise prescription that is based on a frequency, intensity, and duration formula. The primary hypothesis to be tested is that there will be a difference in physical activity and cardiorespiratory fitness measures between the two conditions at the end of 24 months. The secondary hypothesis is that both groups will make significant improvements from baseline in physical activity and cardiorespiratory fitness at the end of 6 months. Six months of active intervention are followed by 18 months of a tapered follow-up maintenance intervention in both groups. Primary outcome measures are measured after 6 and 24 months.

Adult↗

PubMed1998

Six-month physical activity and fitness changes in Project Active, a randomized trial.

PURPOSE: Project Active is a randomized clinical trial (N = 235) comparing a lifestyle physical activity program with a structured exercise program in changing physical activity (total energy expenditure [kcal.kg-1.d-1]) and cardiorespiratory fitness (VO2peak in mL.kg-1.min-1). METHODS: Sedentary but healthy adults (N = 235) aged 35-60 years received 6 months of intensive intervention. RESULTS: Analysis of covariance (ANCOVA), adjusting for baseline measure, age, gender, body mass index (BMI), cohort, and ethnicity, showed that at 6 months both lifestyle and structured groups significantly increased energy expenditure over baseline (P < 0.001). The mean increases +/- SE, 1.53 +/- 0.19 kcal.kg-1.d-1 for the lifestyle group and 1.34 +/- 0.20 kcal.kg-1 d-1 for the structured group, were not significantly different between groups (P = 0.49). For cardiorespiratory fitness, both groups had significant increases from baseline (P < 0.001). Mean increases +/- SE were 1.58 +/- 0.33 mL.kg-1.min-1 and 3.64 +/- 0.33 mL.kg-1.min-1 for the lifestyle and structured groups, respectively. This was significantly greater in the structured group (P < 0.001). We also studied changes in intensity of physical activity. Both groups significantly increased moderate intensity activity from baseline, but the increase was significantly greater in the lifestyle group than the structured group (P = 0.02). In contrast, the structured group increased its hard activity more than the lifestyle group, but the difference was not significantly different (P = 0.02). In contrast, the structured group increased its hard increased (P < 0.01) for both groups by 0.25 kcal.kg-1.d-1. CONCLUSION: Both intervention approaches are effective for increasing physical activity and fitness over a 6-month period in initially sedentary men and women.

Adult↗

PubMed1998

Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings. Activity Counseling Trial Research Group.

Counseling by health care providers has the potential to increase physical activity in sedentary patients, yet few studies have tested interventions for physical activity counseling delivered in health care settings. The Activity Counseling Trial (ACT) is a 5-yr randomized clinical trial to evaluate the efficacy of two primary care, practice-based physical activity behavioral interventions relative to a standard care control condition. A total of 874 sedentary men and women, 35-75 yr of age, have been recruited from primary care physician offices at three clinical centers for 2 yr of participation. They were randomly assigned to one of three experimental conditions that vary, in a hierarchical fashion, by level of counseling intensity and resource requirements. The interventions, which are based on social cognitive theory and the transtheoretical model, are designed to alter empirically based psychosocial mediators that are known to be associated with physical activity. The present paper describes the theoretical background of the intervention, the intervention methods, and intervention training and quality control procedures.

Adult↗

PubMed1997

Minority women and tobacco: implications for smoking cessation interventions.

Quitting smoking is the single most important preventive health behavior a woman can perform to significantly reduce her chances of morbidity and premature mortality. Minority women are an extremely important population to target for smoking cessation intervention. Rates and risk factors for cardiovascular diseases and cancer are markedly higher among women of certain minority groups. In addition, smoking prevalence rates in women of some ethnic groups are elevated relative to the majority population of women, and specific groups have displayed slower rates of decline in smoking. Furthermore, minority women tend to have less access and appear to be less responsive to smoking cessation programs aimed at the majority culture. Thus, consideration of the practical and cultural needs of ethnic minority women is imperative when designing smoking intervention programs. This article describes the smoking behaviors of African-American, American Indian and Native Alaskan, Asian and Pacific Islander, and Hispanic women smokers, in order to gain a greater understanding of the treatment needs of these women. Information on prevalence rates and smoking patterns, barriers to quitting, and findings from intervention studies within each population are reviewed as well as recommendations for smoking cessation treatment.

Female↗

PubMed1997

The challenge of behavior change.

In a culture that is becoming increasingly automated, motivating individuals to choose to be active remains a great challenge. Recognizing that individuals differ in their motivation to become active and then tailoring the counseling message according to the individual's readiness for change have been shown to help spur behavior change. Developing means for designing interventions for moderate activity and additional recommendations for patient-treatment matching will help to promote physical activity.

Choice Behavior↗

PubMed1996

Depression following smoking cessation in women.

The recurrence of depression following smoking cessation has been documented among smokers with a history of depression. This report examines the development of major depression following smoking cessation among three women without notable histories of depression. Shortly after smoking cessation, these women developed significant depressive symptoms requiring psychiatric intervention. These cases seem to support the hypothesis that some smokers may self-treat negative affect with nicotine and underscore the importance of monitoring depressive symptoms in patients undergoing smoking-cessation treatment.

Administration, Cutaneous↗

PubMed1996

Theories and techniques for promoting physical activity behaviours.

The primary goal of this article is to review theoretical models utilised in designing physical activity interventions for healthy adults. Physical activity offers numerous benefits for improved physical and psychological health. However, the majority of the population is sedentary and therefore at increased risk for morbidity and mortality. Many techniques have been developed for intervening with physical activity behaviours, some of which are based on theoretical models. While some of these models show more promise than others, no model is sufficient to thoroughly explain exercise behaviours or how to best intervene. In the final section, recommendations for future research are presented, and promising areas of development in physical activity interventions are discussed. This is not an exhaustive review of theoretical models but rather focuses on models most commonly applied to physical activity.

Adult↗